Fasting before cardiac catheterization: still necessary? A systematic review and meta-analysis of randomized clinical trials

Abstract Background Fasting prior to elective or non-urgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. However, advancements in cardiac catheterization techniques and the use of mild sedation have led to questions about the necessity of this practice. This systematic review and meta-analysis aimed to evaluate the impact of fasting versus non-fasting protocols on patient outcomes and satisfaction. Methods We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and non-fasting states before cardiac catheterization. Eight randomized trials, including a total of 3147 patients, were analyzed. The primary outcome was a composite of adverse events, including pneumonia, hypoglycemia, and nausea/vomiting. Secondary outcomes included individual adverse events and patient satisfaction. Results No significant difference was found in the incidence of composite adverse events between fasting and non-fasting groups (4.9% vs. 4.5%, OR, 1.07, 95%CI, 0.76, 1.50, p=0.69). The incidence of hypoglycemia, pneumonia, and nausea/vomiting did not differ significantly between groups. Patient satisfaction was significantly higher in non-fasting protocols in four out of eight studies. Conclusion Our meta-analysis suggests that fasting prior to elective coronary angiography does not significantly reduce adverse events but may reduce patient satisfaction. These findings support reconsidering the necessity of fasting protocols in this context, although further studies are warranted to confirm these results.